“Critical Care”
Star Trek: Voyager – Season 7, Episode 5
Star Trek has always been steeped in social commentary, and a lot of it is great, but there’s also something kind of generic about much of it. Like, obviously war sucks, racism is bad, etc. Voyager covered a lot of thought-provoking ground as far as these tried-and-true issues went, but “Critical Care” represents an extremely specific (and sadly prescient) parable about a mundane but vital aspect of everyone’s existence: healthcare. It’s a remarkable and even infuriating hour of satire that lays bare the savage inequities and inhumanity of a broken healthcare system.
And to be clear, this episode is very much about America’s healthcare system. As the sole developed nation in the world without any nationalized system of care, the U.S. holds an odious honor of not giving a shit about its citizens in a medical capacity. This isn’t an oversight, but a matter of purposeful policy – it’s a carefully crafted system of inhumanity that maximizes profits off of the backs and corpses of people – adults, elderly, and children. As accustomed to Star Trek’s social commentary as I am, it’s still kind of shocking to see such a uniquely American (and personal) problem depicted here. Trek is of course an American property, but it rarely ever feels this American. I’m trying to think of the last time Trek based a parable on something so tied to the U.S. – The Next Generation’s excellent “The Drumhead” comes to mind, a damning commentary on McCarthyism. After Voyager, Enterprise would commit to a season-long 9/11 allegory that was exactly as much fun as it sounds. For this reason, “Critical Care” is a daring story that is every bit as applicable today as it was 20 years ago.
On a ship floating above a dystopian industrial city, a slimy weasel named Gar (not Jeffrey Combs) is trying to sell medical supplies to an administrator named Chellick. He reveals a particularly high quality piece of merchandise, and whips out the Doctor’s mobile emitter. He activates it, and a visibly confused Doctor appears in the crowded and bustling medical ward. It’s the first of many demonstrations of inhumanity throughout the episode – the Doctor is simply regarded as a very hi-tech piece of medical equipment, not a person. It recalls the way the Voyager crew initially treated him and is an uncomfortable callback to those early episodes. The Doctor protests his apparent kidnapping, but is quickly distracted by a deluge of injured patients streaming in, the result of a mining accident (of course it’s mining). Not being able to ignore a medical emergency, he jumps in and demands a hypospray to treat a wounded patient. “A what?” one of the exhausted med techs asks, and the Doctor adapts with some lower-tech care. Chellick is impressed by the Doctor’s performance.
On Voyager, Paris and Kim visit sickbay for some minor injuries sustained in a holodeck hockey game (oh, these two knuckleheads), only to find a fake version of the Doctor’s program residing in the database. Seems as though that weasel Gar spent the night in sickbay with a feigned illness, and Voyager has fallen victim to yet another con artist thief. Dammit! Janeway vows to track this jerk down and get the Doctor back.
The Doctor’s abilities impress the staff on the medical ship. He wants to contact Voyager to obtain more medical supplies to help the patients, but Voje, the head of the Level Red ward says that establishing communication takes a lot of paperwork – in triplicate. Ah, bureaucracy! The Doctor treats a bright young man names Tebbis who seems to have a chronic chromorviral condition he hasn’t been treated for. Voje explains that Tebbis doesn’t have a high enough “TC” to rate treatment.
Urge to kill: rising.
Chellick comes and informs the Doctor that he has acquired his program from Gar. The fact that the Doctor has just been bought and sold like a slave is a quick and horrifying detail but totally fits in with the society’s value of life. Chellick takes his marching orders from the Allocator, the main computer that makes all the important decisions. Oh, so they’ve automated all the life and death matters to a computer so that actual people don’t have to deal with any of the nitty-gritty details and ethical hazards involved? Efficient!
Urge to kill: approaching critical threshold.
The Allocator has determined that the Doctor’s talents would be best served on Level Blue, a higher priority ward. The Doctor follows Chellick there, expecting it to be an even more urgent hellhole. But instead he finds a clean and well-maintained medical luxury suite where each patient has their own doctor instead of one doctor handling dozens.
URGE TO KILL: Oh, forget it…
These patients have a higher TC, or “treatment coefficient,” so they rate better quality of medical care. The Doctor is morbidly curious as to how that TC is determined, and Chellick explains that the Allocator decides based on the individual’s value to society, as calculated by a complex algorithm. People who have the most important jobs are entitled to the best treatment and… fuck everyone else. Although it seems maximally dystopian, I’d imagine this is only a 5% exaggeration of our current system and something an Elon Musk or Mark Zuckerberg tech bro is working on perfecting.
The chief of medicine Dysek explains that their race was once dying from ecological disasters, and that the system is necessary to provide the best benefit to society with the most efficient use of limited resources. The Doctor observes that the patients here are being treated with cytoglobin, which is the medicine Tebbis needs for his condition. Dysek tells him these patients need it to prevent arterial aging, even though their arteries are in perfect health. Essentially, the valuable people are getting unnecessary preventative medicines to extend their comfy lives while the rest lay sick and dying without getting the medicines they need to survive. COOL.
Dysek says that their society is in better shape than it was since they started following the Allocator’s decisions. The Doctor of course protests this, but Dysek responds that if Tebbis’ TC were to rise, he would rate better treatment. But how could his value to society go up if he’s not well and not able to perform at his best? Tebbis is a victim of the same cruel inequities of our own society, and is caught in the sick paradox that all people on the lower rungs of society are. You can’t access the opportunities to raise your station because your station is too low. Bootstraps, people!
The Doctor returns to Level Red to check on Tebbis and sees that he’s getting worse. His TC is too low to allow him any more treatment. The Doctor suggests just inputting higher values into his profile to raise the TC. Dr. Voje reluctantly tries, but the system rejects it. Even though he’s sick and dying, Tebbis tries to ease the Doctor’s conscience and resigns himself that he’s not valuable enough to deserve treatment.
F-U-U-U-U-U-U-U-U-U-U-
The Doctor goes back to Level Blue and tricks a nurse into giving him an extra dose of cytoglobin to administer to a patient of his. Instead, he sneaks it back down to Level Red and gives it to Tebbis. Having finagled a broken system to help someone in need, the Doctor gives a satisfied smile in what is a quietly triumphant moment.
Tebbis starts to improve, and the Doctor says yeah, that’s what happens when you get actual treatment. He starts bringing more cytoglobin down for the people in need. Frightened of the consequences, Voje doesn’t want anything to do with it. Tebbis happily volunteers to help the Doctor give the injections, and Voje reluctantly decides to help, too. It’s an unfortunate illustration of how a broken system causes people to fall in line for fear of their livelihoods. Why do the right thing if it will get you fired? Who can afford to be a good person under such abhorrent circumstances?
Unfortunately, Dysek discovers that the Doctor is prescribing unnecessary medications for his patients. The Doctor slickly tells him that the Allocator uses last month’s requisitions to determine the next month’s requisitions. If Dysek orders less medicine one month (because his patients are improving), the Allocator will give him less in the future, and it could affect his treatment stats, potentially hurting his career. But if they order more, the Doctor explains they can have some leftover to prevent this. Chellick senses something is afoot, but after a pause, Dysek reassures him that the Doctor is actually catching onto the system very well. The Doctor’s cleverness here is awesome, and it’s immensely satisfying to see him gaming the system from both ends. Indeed, in real life a surgeon’s patient survival record is a thing and they’ve been known to turn down risky operations for fear of lowering their success rate and the negative career consequences that can result. The Doctor uses this threat to conscript Dysek into his scheme.
The Doctor happily tells Voje that meds will be delivered to Level Red on a regular basis. Tebbis continues to improve and he shows off a scanning device he fixed. He’s smart and already demonstrating how valuable he potentially could be to society if given the chance (although, it’s worth noting that any life has an intrinsic value, regardless of what they can contribute to society – everyone deserves to live no matter what duties they can perform for the collective good). He even wants the Doctor to still mark him as sick so he can stay and help treat patients and learn how to be a doctor. Everything seems to be working out well.
But later on at night, the Doctor comes to check in on Tebbis again. Voje informs him he’s been moved to Level White. The morgue.
The Doctor angrily confronts Chellick about that boy who died. Chellick gives him a blank look, stating he’s responsible for thousands of patients. The Doctor gives Tebbis’ patient number and Chellick checks his computer. Apparently he developed a secondary infection that wasn’t treated – his allotment of medication had been used up and he was left to die, literally by the system. “Did you think I wouldn’t find out?” Chellick asks, a twinge of cruelty in his voice.
The Doctor is silent in response, his mouth agape. Picardo holds the Doctor’s horrified expression for several beats and it allows the awful weight of what’s happened to soak in perfectly – a life full of potential snuffed out because of some numbers in a fucking computer. He looks like he’s about to either cry or scream, and we’re right there with him. He softly but furiously demands – “Don’t you have any ethical standards?” Because he’s from the enlightened, post-scarcity society of the Federation, the Doctor is completely flummoxed by the inhumanity of this system. To purposefully not treat someone – and in doing so killing them – because of some algorithm is an awful, awful, awful idea that the Doctor can’t fathom. “Why don’t you just put a phaser to their heads?” he asks.
The Doctor says he was trying to save lives, and Chellick angrily responds that he’s tying to save an entire society. A boy like Tebbis had nothing to contribute as per the Allocator’s determination, so why waste valuable resources on him? He was a drain. Chellick even says that if he had been fitter, he would have survived – basically, he clearly didn’t deserve to live. (The fact that Chellick would be considered obese under the standard – though admittedly very faulty and overly simplistic – BMI standard doctors in the U.S. use adds an interesting wrinkle to this particular line of dialogue) This is an absolutely monstrous notion that is unfortunately not an exaggeration of current attitudes you’re likely to hear from any number of (conservative) political figures.
It’s a brief but elegantly written argument with a lot of angering ideas. “You’re not just rationing healthcare, you’re getting rid of the sick and the weak!” The Doctor threatens to expose Chellick, who responds indignantly – “To whom? The people who employ me? They brought me here to make the hard choices they don’t want to make.” To the actor’s credit, he doesn’t play Chellick as a dastardly evil man, but simply a mild-mannered administrator. He’s ostensibly the villain of the episode, but he’s merely a cog in the machine that’s the true evil here. Chellick’s people are apparently efficient administrators and have been contracted by the Dinaali to run their medical system. They’ve chosen to outsource their ethical quandaries to someone else, and Chellick has outsourced his decisions to the Allocator – who isn’t even a person. It’s just a huge circle of moral surrender and responsibility-shirking. It can’t be anyone’s fault, because there’s a higher force to pass the buck off to. The Allocator itself was programmed by people, but they can surely shrug their ethical responsibility off to other forces. It’s sick and dizzying.
Chellick brings the hammer down on the Doctor and ties his program into the Allocator, which – true to its name – starts allocating the amount of time the Doctor can spend with each patient, down to the minute. It forcibly moves him to each patient’s bedside and announces precisely how much time he has to treat them. It would be hilariously Kafkaesque if it wasn’t so maddening and terrible.
The Doctor messages Voje to come up and see him (who’s never even been to Level Blue, and is amazed by it). As the Doctor talks to Voje, the Allocator continues shifting him around the room as his time with each patient expires. It’s absurd, almost comical (at one point, the frustrated Doctor hands his tool to Voje before he’s dematerialized to another part of the room). He convinces Voje to smuggle his mobile emitter back down to Level Red. Voje is indignant, given the damage the Doctor has already caused. Despite the risk of death, all the patients they treated with the stolen medicine are being released because they blew through their annual medicine allotments in a matter of days (let that cruel fact sink in). But the Doctor has a plan to help them and convinces Voje to sneak him out.
What happens next is… crazy.
In Level Red, it doesn’t take long for Chellick to arrive and see that the Doctor has wriggled out from his grasp. Exasperated, he’s decided the Doctor is too much trouble to keep around and tries to deactivate him, but the Doctor incapacitates him with an injection and lays him down on a table. Bending over to meet his gaze, the Doctor snarls, “I’m going to make you a patient in your own hospital.”
Hoo boy. Karmically, it’s exactly what Chellick deserves and I couldn’t help but instinctively cheer at the well-served comeuppance, but it’s a hell of a character and plot swerve. The Doctor has given Chellick not only a neural blocker to slightly (and temporarily) paralyze him, but he also infects him the the same chromovirus so many neglected patients down there die from. Oh, and also Tebbis’ bio-signature – so that the Allocator reads Chellick as a lowly laborer with a dismal TC.
Yeah. It’s nuts, and so far outside the bounds of a normal Star Trek hero. Not since Sisko’s morally grey (to say the least) actions in “In the Pale Moonlight” or “For the Uniform” have we had a lead character go this far to the dark side. Just as in the case of Captain Sisko, the Doctor does this for a good cause. But at least in those Deep Space Nine stories, the shock value of Sisko’s actions is underlined and communicated by the episode. I don’t think this episode is as strong in dealing with the depth of what the Doctor does here, but anyway.
Chellick starts to feel the effects of the virus. The Doctor asks the Allocator for the proper treatment, but reading Chellick as Tebbis, it refuses to give him the medicine he needs. Oh no. Voje is horrified by what the Doctor has done, but as he tells Chellick, he’s not authorized to give him the medicine, either. The system literally won’t give it to him. Chellick orders him to get Dysek, who arrives and hesitates to give him the cytoglobin, as well. Just following the rules, he says. “I made those rules!” a worsening Chellick gasps. “Then you should be pleased I hold them in such high regard,” Dysek responds. It’s a bit of an unexpected heel turn from him, as well – it’s not like he’s a good person who’s ready to tear down the system he lives comfortably in. But he’s not going to stick his neck out and get in trouble, either.
The Doctor strong arms Chellick into allowing the people on Level Red to receive all the cytoglobin they need – by diverting the unnecessary injections the patients on Level Blue enjoy. Right on time, Chakotay and Torres beam down to extricate the Doctor from the Allocator’s system. Chellick agrees to the Doctor’s demands so he can receive the cure himself.
As great and nuanced as the episode has been up to this point, the resolution is pretty pat and simplistic. Of course the Doctor was never going to destroy this gigantic system, but I’m not sure how much this bargain under duress is going to help matters. What’s to stop Chellick from going back on his word once Voyager leaves? Is he just going to forgive and forget with Dysek? Even if all the current crop of patients in Level Red get better, is any of this going to help anyone after that? It’s a very ephemeral victory at best.
On Voyager, the Doctor gives Seven her regular checkup, and then asks for one in return (which is cute). She analyzes his program for any errors, but doesn’t find any. He tells her about what he did, how he intentionally harmed a person and broke the basic oath he was programmed with. Seven tries to interpret his assault as a means to help others, but the Doctor isn’t comforted by it. He was hoping what he did was a result of a program malfunction, but he’s in perfect health and Seven is unable to alleviate his guilt. Once again pushed beyond the limits of his original parameters, the Doctor finds himself in uncharted waters and will have to deal with the emotional consequences of his actions by himself.
“Critical Care” is one of the most biting and incisive pieces of social commentary Star Trek has ever done. In a time when healthcare is more of a public concern that it’s ever been, and when income inequality is greater than ever, the angering issues at the heart of the episode ring loud and true. The United States loves to tout itself as a land of freedom, opportunity, and wealth, but those things are only within reach of a scant few. Health is an integral part of all of those values, and a humane, universal health care system is the only way for an enlightened society to deliver those promises. Instead, the U.S. has shirked its responsibility to its people and so many have paid the price. The well-drawn dystopian society in “Critical Care” is barely an exaggeration of our own dystopian system that keeps so many ill, impoverished, or worse. We can certainly fault the Doctor for breaking his oath, but what about a society that has done the same of its own oath to protect its people?
Stray Observations:
- Combining a deathly serious A-plot with a humorous B-plot seems like a recipe for disaster, but this episode actually strikes a nice balance with Janeway and the crew’s search for Gar, the thief who stole the Doctor’s program. Janeway has to track down Gar by following a trail of cheated clients, broken hearts, and stolen loves, and her increasingly bored and exasperated expressions on the bridge are quite funny. The comedic crescendo comes when she pretends to be romantically involved with Tuvok, and reaches over to hold his hand. Tuvok is of course befuddled beyond belief, which is also really funny. When they finally capture Gar, Tuvok softly threatens to do a mind meld, and Neelix poisons the guy with extra spicy food to coerce him to cooperate. This is just an episode chock full of righteous revenge, inn’t?
- The film Elysium would pretty much use the same plot as this episode – rich people in an orbital platform having access to infinite healthcare while the poor people on the surface are afforded barely the basics.
- Star Trek has featured many a society run by a computer, but I got vibes of the Custodian from TNG’s “When the Bough Breaks.” Interestingly, we don’t find out much about the Allocator here, and it certainly isn’t defeated as these computers often are.
- I don’t want to make too much of Chellick’s appearance, but his skin has a reddish, blotchy appearance – almost like lupus. We see another of his race in the episode who doesn’t have the same markings, and it might point to Chellick maybe not being in the best of health? It’s some subtle irony, given his comments about other people’s health and how it relates to their right for life (and the fact that he’s a high-ranking healthcare worker).
- Gregory Itzin has had many a role on Star Trek, including one of Morn’s co-conspirators in “Who Mourns For Morn?”
- Nice work on the planet shots of the hospital ship. Like in “Dragon’s Teeth,” this is something we don’t see that much in Star Trek. The design of it is cool. From above during day it looks like just another alien ship, but at night from below it’s much more threatening and spider-like.
